Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• x V
a COMMUNITY DEVELOPMENT Permit #: ELR2010 -00126
'T 1 G f R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/21/2010
Parcel: 1 S135AB01006
Jurisdiction: Tigard
Site address: 10500 SW GREENBURG RD 100
Subdivision: LINCOLN PLAZA Lot: 0
Project: Beal Bank
Project Description: (1) voice /data telecommunications and (1) video system
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 07/21/2010 $150.00
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 07/21/2010 $18.00
PHONE:
Contractor:
ALLPHIN COMMUNICATIONS INC
23220 SW BOSKY DELL LANE
WEST LINN, OR 97068
PHONE: 503 - 638 -9000
FAX: 503 - 638 -9100
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: N Boiler Controls: N
CCTV: Y Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC: N Instrumentation: N Total $168.00
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0010 throug +AR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 5 6.6699 or 1.800.332.2344.
Issued B `� Permittee signature: r i�!
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application:; L ', r . - • ; - FOR OFFICE USE ONLY
City of Tigard Receive a 7 �i / o ` — / Permit No.: �(Q�29 /p - 4,2 1.
II • 13125 SW Hall Blvd., Tigard, OR 97223 f q Plan Revie •
G Phone: 503.639.4171 Fax: 503.598.1 �+ 1 2 0 1 0 Date /B : Other Permi6661-7,6/ a _ ,e)Q /
T I G A R D Inspection Line: 503.639 „• Date Ready /By: ME ® See Page 2 for
Internet: www.tigard- or.gov F.. - l' Notified Meth Supplemental Information
TYPE OF'WORK PLAN REVIEW
❑ New construction rg Addition/alteration / replacement
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling Ei Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: ,�++ /� 100HP or more. occupancy.
/DS St.J 17/'ceN4 12 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 1 t ' rordt 0 C 2Z g ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: ' 00 Project name: O {4 1.. d,Jk. ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. 1 Total 1 *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIp'�IQN OF WORK (with above sq. ft.) 67.84 2
r /� � S Limited energy, multi-family above q. ) 67.84 2
C0) //454)-1( Ua Le P�TJ / t 11J v( .(c,� -s residential (with above s . ti.
r Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/Z1P: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that i own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
tY dwelling, service and/or feeder
Phone: ( ) Fax:: ( ) Reconnect only 67.84 - 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy -.,
panel, alteration, or extension. L Page 2 /V 0. rt 2
Business name: t j 0,00,‘1,,,,t Jro j t , q (_ jili Each additional inspection over allowable in any of the above
Address: , 232 2 0 s g oos t(r 0Y a,! Lit/
Additional inspection (1 hr min) 66.25/ hr
( Investigation (I hr min) 66.25/ hr
City/State /ZIP:
(A) .eS . (i ;� OIt ci -7 O4 Industrial plant (I hr min) 78.18/ hr
hr min)
P one: (fp"3) ( U r �� O Fax: ( 503 3 g/00 Inspections for which no fee is
specifically 90.00/ hr
ELECTRICAL PERMIT FEES
listed ('.4
CCB Lic.:) t9 pi(? Electrical Lic.: 3-. LleSuprv. Lic.: Z(,l �OZ
/ Subtotal: 15'6 ,
Suprv, Electrician signature, required: t o). Plan review (25% of permit fee):
Print name:�� �f ( Lo. Ur `( , n � � Date: ' / ko State surcharge (12% of permit fee): (� ,
`�' TOTAL PERMIT FEE: /6 f e , v"
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
1: \ Building \ Permits \ELC- PermitApp.doc 10/01/09 440- 4615T(1I /05,COM'WEB